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Open Access 01-12-2016 | Study protocol

DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso

Authors: Charles Kaboré, Valéry Ridde, Séni Kouanda, Ludovic Queuille, Paul-André Somé, Isabelle Agier, Alexandre Dumont

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

Since 2006, Burkina Faso has subsidized the cost of caesarean sections to increase their accessibility. Caesareans are performed by obstetricians, general practitioners, and nurses trained in emergency surgery. While the national caesarean rate is still too low (only 2 % in 2010), 12 to 24 % of caesareans performed in hospital are, in fact, not medically indicated. The objective of this study is to evaluate the effectiveness and analyze the implementation of a multi-faceted intervention to lower the rate of non-medically indicated caesareans in Burkina Faso.

Methods

This study combines a multicentre cluster randomized controlled trial with an implementation analysis in a mixed-methods approach. The evidence-based intervention will consist of three strategies to improve the competencies of maternity teams: 1) clinical audits based on objective criteria; 2) training of personnel; and 3) decision-support reminders of indications for caesareans via text messages. The unit of randomization and of intervention is the public hospital equipped with a functional operating room. Using stratified randomization on hospital type and staff qualifications, 11 hospitals have been assigned to the intervention group and 11 to the control group. The intervention will cover 1 year. Every patient who delivered by caesarean during a 6-month period in the year preceding the intervention and the 6 months following its end will be included in the trial. The change in the rate of non-medically indicated caesareans is the main criterion by which the intervention’s impact will be assessed. To analyze the intervention process, a longitudinal qualitative study consisting of deliberative workshops and individual in-depth interviews will be conducted. The target outcome is a 50 % reduction in the rate of non-medically indicated caesareans.

Discussion

This study will provide evidence regarding the effectiveness of a multi-faceted intervention for reducing non-medically indicated caesareans in a low-income country. By combining qualitative and quantitative methods, the study’s findings will allow understanding the factors that could influence the intervention process and ultimately the intended outcomes.

Trial registration

The DECIDE trial is registered on the Current Controlled Trials website under the number ISRCTN48510263 on January 28, 2014.

Available only for authorised users

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Title: DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso
Authors: Charles Kaboré
Valéry Ridde
Séni Kouanda
Ludovic Queuille
Paul-André Somé
Isabelle Agier
Alexandre Dumont
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-1112-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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